Website:
medpinn.net
Job details:
Job Summary
We are looking for an experienced Workers’ Compensation Appeals Specialist to manage the appeals process for denied Workers’ Compensation (WC) claims. The ideal candidate should have a strong understanding of WC claim denials, SBR (Second bill review), payer requirements, and appeal submission processes.
The specialist will be responsible for reviewing denied claims, identifying the root cause of denials, gathering supporting documentation, and submitting accurate and timely appeals through DaisyBill and other payer portals.
Key Responsibilities
- Review and analyze Workers’ Compensation claim denials and determine the appropriate resolution.
- Prepare and submit appeals for denied WC claims within payer and regulatory filing deadlines.
- Handle SBR-related claims and appeals through DaisyBill.
- Research denial reasons and determine whether claims require reconsideration, corrected billing, documentation, or formal appeal.
- Prepare strong, well-supported appeal letters with appropriate documentation.
- Review medical records, EOBs/denial letters, claim forms, authorization information, and supporting documentation.
- Ensure appeals comply with applicable Workers’ Compensation rules, payer guidelines, and filing requirements.
- Follow up on submitted appeals and track their status through resolution.
- Identify recurring denial trends and communicate opportunities for process improvement.
- Maintain accurate notes and documentation in the appropriate billing systems.
- Meet established productivity, quality, and turnaround-time requirements.
Required Qualifications
- Strong experience with Workers’ Compensation medical billing and appeals.
- Strong understanding of WC denial codes, denial reasons, and appeal requirements.
- Hands-on experience preparing and submitting WC appeals.
- Strong knowledge of SBR requirements and processes.
- Ability to independently research a denial and determine the appropriate appeal strategy.
- Excellent written and verbal communication skills.
- Strong attention to detail and ability to meet strict filing deadlines.
- Experience working with US healthcare Revenue Cycle Management.
Preferred / Advantageous Skills
- DaisyBill experience — strongly preferred.
- Waystar experience — an advantage.
- Experience with other claims clearinghouses and payer portals.
- Experience handling medical billing for Workers’ Compensation providers.
- Experience with claim follow-up, denials management, and AR.
Ideal Candidate
The ideal candidate is someone who can independently take a denied Workers’ Compensation claim, understand why it was denied, determine whether it is appealable, prepare the appropriate documentation and argument, and submit a complete appeal within the required timeframe.
DaisyBill experience is highly preferred, while Waystar experience will be considered an added advantage.
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